Tag Archives: WASH nutrition integration

WASHplus Weekly: Focus on WASH & Nutrition

WASHplus Weekly | Issue 171| Dec 12, 2014 | Focus on WASH & Nutrition

This issue provides updates on new resources since the September 2014 WASHplus Weekly on WASH and nutrition with links to a December 15, USAID webinar; the recently published Global Nutrition Report; presentations at the UNICEF Stop Stunting Conference in India; and just-published studies on stunting, environmental enteropathy, and other WASH and nutrition topics.

EVENTS

December 15, 2014, Draft Guidance for USAID-Funded Nutrition-Sensitive ProgrammingLink
During this webinar, Richard Greene, senior deputy assistant administrator with USAID’s Bureau for Food Security, will share a two-page draft guidance document that will assist implementers in applying the new USAID Multi-Sectoral Nutrition Strategy to nutrition-sensitive agriculture programs.

November 19–21, 2014, The Second International Conference on Nutrition
(ICN2)
Link | Vision statement
The Second International Conference on Nutrition (ICN2) was a high-level intergovernmental meeting that focused global attention on addressing malnutrition in all its forms. The two main outcome documents—the Rome Declaration on Nutrition and the Framework for Action—were endorsed by participating governments at the conference, committing world leaders to establishing national policies aimed at eradicating malnutrition and transforming food systems to make nutritious diets available to all.

November 10–12, 2014, UNICEF Stop Stunting Conference, India. Link
The Stop Stunting regional conference provided a knowledge-for-action platform where state-of-the-art evidence, better practices, and innovations were shared to accelerate sectoral and cross-sectoral policies, programs, and research in nutrition and sanitation to reduce the prevalence of child stunting in South Asia.

REFERENCE MANUALS

Global Nutrition Report, 2014. International Food Policy Research Institute. Link | WaterAid review of the Global Nutrition Report
The first-ever Global Nutrition Report provides a comprehensive narrative and analysis on the state of the world’s nutrition. The Global Nutrition Report convenes existing processes, highlights progress in combating malnutrition, and identifies gaps and proposes ways to fill them. Through this, the report helps to guide action, build accountability, and spark increased commitment for further progress toward reducing malnutrition much faster.

Water, Sanitation and Hygiene in Nutrition Efforts: A Resource Guide, 2014. WASH Advocates. Link
This resource guide includes manuals, reports, academic studies, and organizations working on WASH and nutrition. The guide can serve as a tool for implementers and advocates in the WASH/Nutrition nexus looking to pursue and promote integrated programming.

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Beyond Malnutrition: The Role of Sanitation in Stunted Growth

Below are the 3 latest posts to the WASH Nutrition Library, http://blogs.washplus.org/washnutrition that is maintained by the USAID Community of Practice on WASH and Nutrition. If your organization has recent studies that we can add to the library, please let us know.

  • ​Beyond Malnutrition: The Role of Sanitation in Stunted Growth
  • Reframing Undernutrition: Faecally-Transmitted Infections and the 5 As
  • Understanding the Rapid Reduction of Undernutrition in Nepal, 2001–2011:​

Beyond Malnutrition: The Role of Sanitation in Stunted GrowthEnv Health Perspect, Nov 2014

Author: Charles W. Schmidt

An excerpt from the article: Beyond Nutrition – Nutritionists have tried dozens of approaches to prevent stunting, such as micronutrient supplements for pregnant women and children (especially growth promoters including iron, zinc, calcium, and folate); increased availability of fat-fortified commercial products such Nutributter and Plumpy’nut; a concerted push to encourage breastfeeding during the first six months of life; and efforts to improve the nutritional quality of the complementary foods babies eat while weaning.6

But Jean Humphrey, a professor of human nutrition at the Johns Hopkins Bloomberg School of Public Health, says none of these interventions has been able to eliminate stunting completely. At best, she says, they improve growth by about a third of the typical height deficit in stunted Asian and African children. “This tells us that dietary improvements are important but not sufficient,” she says. “If we really want to eliminate stunting, we need to do more.”

Meanwhile, mounting evidence has shown that poor hygiene and sanitation also constrain linear growth in children. One study found that Bangladeshi children who had access to clean drinking water, improved toilets, and facilities for handwashing with soap, for instance, had a roughly 50% improvement in HAZ scores compared with control children who didn’t.18 Similar results emerged from studies in Sudan19 and Mexico,20 yet it was unclear exactly why poor WASH would contribute to stunting and WASH improvements would help to ameliorate it.

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Reframing Undernutrition: Faecally-Transmitted Infections and the 5 As, October 2014.

Robert Chambers and Gregor von Medeazza, Institute of Development Studies.

The dominant nutrition discourse concerns access to adequate food and its quality. It now includes food security, food rights and justice, governance and agriculture. Despite many initiatives to assure food access, and growing economies, high levels of undernutrition persist in much of Asia. It is increasingly suggested that much of this ‘Asian enigma’ can now be explained by open defecation (OD) combined with population density. However, the insight that ‘shit stunts’ remains a widespread blind spot. The persistence of this blind spot can in part be explained by factors which are institutional, psychological and professional.

Reductionist focus on the diarrhoeas, which are serious, dramatic, visible and measurable, has led to the relative neglect of many other often subclinical and continuously debilitating faecally-transmitted infections (FTIs) including environmental enteropathy (EE), other intestinal infections, and parasites. These are harder to measure but together affect nutrition much more: the diarrhoeas are only the tip of the much larger sub-clinical iceberg. How OD and FTIs, poverty and undernutrition reinforce each other is illustrated in this paper by looking at the case of India, which has about 60 per cent of the OD in the world, around a third of the undernourished children, and approximately a third of the people living in poverty. Through OD, FTIs and in other ways, lack of sanitation leads to losses, which may be estimated, in the range of 1 to 7 per cent of GDP in various countries.

To reframe undernutrition for a better balance of understanding and interventions, we propose two inclusive concepts: the FTIs and the 5 As. The first two As – availability and access – are oral, about food intake, while the last three As – absorption, antibodies and allopathogens – are novel categories, anal and internal, about FTIs and what happens inside the body. These concepts have implications for research, professional teaching and training, and policy and practice. While other countries make rapid progress towards becoming open-defecation free, India remains obstinately stuck, making undernutrition in India one of the great human challenges of the twenty first century. The concepts of FTIs and the 5 As reframe more inclusively how undernutrition is perceived, described and analysed. Our hope is that this reframing will contribute however modestly to a cleaner, healthier and happier world in which all children and adults are well-nourished and can grow and live to their full potential.

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Understanding the Rapid Reduction of Undernutrition in Nepal, 2001–2011: IFPRI Discussion Paper 01384, 
October 2014.

AUTHORS: Derek D. Headey (d.headey@cgiar.org) is a senior research fellow in the Poverty, Health, and Nutrition
Division of the International Food Policy Research Institute (IFPRI), Washington, DC.

John Hoddinott is a senior research fellow in the Poverty, Health, and Nutrition Division of IFPRI,  Washington, DC.

Abstract: South Asia has long been synonymous with unusually high rates of undernutrition. In the past decade, however, Nepal has arguably achieved the fastest recorded decline in child stunting in the world and has done so in the midst of civil war and postconflict political instability. Given recent interest in reducing undernutrition–particularly the role of nutrition-sensitive policies–this paper aims to quantitatively understand this surprising success story by analyzing the 2001, 2006, and 2011 rounds of Nepal’s Demographic Health Surveys.

To do so, the authors first construct and test basic models of the intermediate determinants of child and maternal nutritional change and then decompose predicted changes in nutrition outcomes over time. They identify four broad drivers of change: asset accumulation, health and nutrition interventions, maternal educational gains, and improvements in sanitation.

Many of these changes were clearly influenced by policy decisions, including increased public investments in health and education and community-led health and sanitation campaigns. Other factors, such as rapid growth in migration-based remittances, are more a reflection of household responses to changing political and economic circumstances.

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Focus on WASH & Nutrition: WASHplus Weekly, Sept 5, 2014

Issue 160 | Sept 5, 2014 | Focus on WASH & Nutrition

This issue contains some of the most recent studies on stunting, open defecation, nutritional interventions, and other WASH and nutrition issues. Recent reports from the World Bank Water and Sanitation Program discuss the impacts of improved sanitation on child growth in Vietnam and Lao PDR. Training materials include the new Global Handwashing Day guide from the Global Public-Private Partnership on Handwashing and a WASHplus infographic on tippy taps.

BLOG POSTS WASHPlus_HTMLbanner_weekly_600x159

Left, Right, and Toilets. Ideas for India, Aug 2014. D Spears. (Link)
Eliminating open defecation in India is a policy priority. This column contends that successful strategies for reducing open defecation may not fit policy stereotypes of the left or the right. While rural sanitation policy in states where this practice is most concentrated has been focused on latrine construction, promotion of latrine use is what will make a difference.

What Do Toilets Have To Do with Nutrition? More Than You Might Think. IFPRI Blog, July 2014. L Haddad. (Link)
A new working paper from the Institute of Development Studies has looked at data from 116 low- and middle-income countries from 1970 to 2012. It found that access to safe water (20 percent) and improved sanitation (15 percent) explained 35 percent of the variation in stunting rates across countries and time periods. This reflects two things: the fact that water and sanitation are strongly linked to stunting reduction, and that both water and sanitation coverage have increased strongly in the past four decades.

JOURNAL ARTICLES BY PUBLICATION DATE

The Effect of India’s Total Sanitation Campaign on Defecation Behaviors and Child Health in Rural Madhya Pradesh: A Cluster Randomized Controlled TrialPLoS Medicine, Aug 2014. R Sumeet. (Link)
The objective of this study is to measure the effect of the Total Sanitation Campaign implemented with capacity building support from The World Bank’s Water and Sanitation Program in Madhya Pradesh on availability of individual household latrines (IHLs), defecation behaviors, and child health (diarrhea, highly credible gastrointestinal illness [HCGI], parasitic infections, anemia, and growth). The intervention led to modest increases in availability of IHLs and even more modest reductions in open defecation. These improvements were insufficient to improve child health outcomes. The results underscore the difficulty of achieving adequately large improvements in sanitation levels to deliver expected health benefits within large-scale rural sanitation programs.

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WASH, Nutrition and Early Childhood Development: New Evidence in ECD and Findings from the Field

Presenters for this June 25, 2014 webinar:

  • Jenny Orgle, Program Director for the Nutrition at the Center Program at CARE USA, will talk about “Addressing Environmental Enteropathy in CARE’s Nutrition at the Center Program.”
  • Maureen Black, Ph.D., Professor, Department of Pediatrics, University of Maryland School of Medicine, will talk about “New Evidence Linking Nutrition and Early Child Development” and its connection to WASH.
  • Moderated by Helen Petach, USAID, Bureau for Global Health, Office of Health Infectious Diseases and Nutrition

Download/view the presentation slides

WASHplus – WASH/Nutrition Literature Update – March 2014

WASH/Nutrition Literature Update – March 2014

The March 2014 literature update includes details on an upcoming USAID-sponsored WASH nutrition presentation on April 1, 2014, and the March 2014 issue of USAID’s Global Waters magazine with descriptions of USAID WASH and nutrition efforts in Liberia and other countries. Other resources include a 2014 WHO report on childhood stunting, an award winning poster on food hygiene, an enteropathy study in Zimbabwe, and other resources.

USAID-SPONSORED EVENTS

April 1, 2014 – Integrating WASH and Nutrition: Current Approaches, Lessons Learned, and Considerations for Future Programming, a presentation by Francis Ngure, Water and Sanitation Program.  Date: Tuesday, April 1, 2014 | Time:  3-4:30 pm | Place: USAID, Room 4.08 E/F, Ronald Reagan Bldg. (RSVP/additional info)
You are invited to a presentation on current strategic and operational approaches linking WASH and nutrition programming based on an investigation conducted by the World Bank Water and Sanitation Program. The session will include preliminary findings and lessons learned from field examples that will inform future programming.

STUDIES/REPORTS

WASH Benefits Study/Bangladesh & Kenya – (Website)
The WASH Benefits Study will provide rigorous evidence on the health and developmental benefits of water quality, sanitation, hand washing, and nutritional interventions during the first years of life. The study includes two cluster-randomized controlled trials to measure the impact of intervention among newborn infants in rural Bangladesh and Kenya. Both will be large in scope and measure primary outcomes after two years of intervention.

Stunting Is Characterized by Chronic Inflammation in Zimbabwean Infants.  PLoS One, Feb 2014. A Prendergas. (Link)
Stunting began in utero and was associated with low maternal IGF-1 levels at birth. Inflammatory markers were higher in cases than controls from 6 weeks of age and were associated with lower levels of IGF-1 throughout infancy. Higher levels of CRP and AGP during infancy were associated with stunting. These findings suggest that an extensive enteropathy occurs during infancy and that low-grade chronic inflammation may impair infant growth.

Could Poor Sanitation Begin Stunting Children in Utero? 2014. D Spears. (Blog post)
Evidence is building up that enteropathy may matter a great deal.  Andrew Prendergast and nine coauthors published a new paper in PLoS One: “Stunting Is Characterized by Chronic Inflammation in Zimbabwean Infants.”  They collected data on about 14,000 infants at periodic intervals in their first 18 months of life. They ended up with a sample of 101 stunted infants—meaning too short—and 101 non-stunted infants in order to have a healthy comparison group. The paper is important because it speaks to the hypothesis of enteropathy as a determinant of stunting among poor children who grow up exposed to intestinal disease.

Water, Sanitation, and the Prevention of Stunting:  An Holistic View of Why Food Isn’t Enough, 2014. J Griffiths. (Presentation)
Poor populations will likely eat aflatoxins in foods; many will have environmental  enteropathy and live without good water or sanitation. Lacking WASH and barriers to fecal contamination, they will have a different spectrum of gut bacteria than people with good WASH.

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Jan 2014 – WASH/Nutrition Literature Updates

WASH/Nutrition Literature Update – January 2014

This update contains recent studies and reports on WASH and nutrition issues plus updates on new publications and resources from members of the USAID Community of Practice on WASH and Nutrition. Please contact WASHplus if you have new publications or upcoming events you would like to feature in the February 2014 update. Most of the studies below can also be found on the WASH/Nutrition Library at: http://blogs.washplus.org/washnutrition.

UPDATES FROM COP MEMBERS – New Publications, Upcoming Events, etc.

Alive & Thrive – Ensuring Adequate Nutrient IntakeInsight, Issue 7, 2013.  (Link)
This issue examines why infants require a much higher quality diet than other members of the household, identifies nutrient gaps in typical complementary food diets, and describes strategies for achieving adequate nutrient intake among children 6-24 months old.

FANTA III – Nutrition Assessment, Counseling, and Support (NACS): A User’s Guide, 2013. (Link)
The NACS User’s Guide is a series of modules that provide program managers and implementers with a package of essential information and resources. These modules are living documents and will be updated as appropriate when new evidence, guidelines, or field experience emerges.

London School of Hygiene & Tropical Medicine (LSHTM) – Water, Sanitation and Hygiene (WASH), Nutrition and Infection: Learning Module Update(Link)
The latest evidence from a Cochrane systematic review found a small but significant improvement in the growth of children under the age of 5 who have access to clean water and soap. Analysis of the data from 14 studies conducted in low and middle income countries suggested that interventions to improve the quality of the water in the household and provide soap resulted in an average 0.5 cm increased height growth in children under the age of 5.

USAID SPRING Project – The Nigeria Community and Facility Infant and Young Child Feeding Package, 2013. (Link)
This Infant and Young Child Feeding Package is a necessary tool to ensure uniform training and information sharing throughout Nigeria.

REPORTS

USAID DRAFT Agency-wide Nutrition Strategy [public comment sought], December, 2013. (Link)
A technical working group, comprising individuals across USAID, has developed a draft nutrition strategy and is seeking public comment.

Cyclosporiasis: An Emerging Potential Threat for Water Contamination. Water and Health 2014. H Ahmad. (Abstract)
Cyclospora cayetanensis is an emerging protozoan parasite that causes small intestine gastroenteritis. There is apparently a worldwide distribution, including regions of endemicity, for example, in Nepal, Haiti, and Peru. Due to the lack of a quantification technique, there is limited information on the prevalence of Cyclospora in water environments, necessitating the need for further research on pathways and transmission dynamics and encouraging innovative research in water treatment for improving sanitation and public health.

Public Health and Social Benefits of At-House Water Supplies, 2013. (Link)
B Evans et al.
The headline conclusion from this research is that at-home water supply has significant, measurable benefits when compared with shared water supply outside the home provided that the service is reliable enough to ensure access to adequate quantities of water when required. Reliable at-home water supply results in higher volumes of water consumption, greater practice of key hygiene behaviors, a reduction in musculoskeletal impacts associated with carrying water from outside the home, and improved water quality.

Sanitation and Externalities: Evidence from Early Childhood Health in Rural India, 2014. The World Bank. (Link)
This paper examines two sources of benefits related to sanitation infrastructure access on early childhood health: a direct benefit a household receives when moving from open to fixed-point defecation or from unimproved sanitation to improved sanitation, and an external benefit (externality) produced by the neighborhood’s access to sanitation infrastructure.

Social Protection and Resilient Food Systems: The Role of Cash Transfers, 2013. Overseas Development Institute. (Link)
If linked to education and awareness-raising, cash transfer programs can improve water and sanitation hygiene practices.

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December 2013 WASH/Nutrition Literature Update

Below are updates on news and events from members of the USAID Community of Practice (COP) on WASH and Nutrition and links to recent studies and reports added to the WASH/Nutrition Library. Please send an email if you have a recent publication or an upcoming event that we can feature in the update. The aim is to send these out every 1 to 2 months.

REPORTS

Growing Tall and Smart with Toilets, 2013. Water and Sanitation Program. (Link)
The research in Cambodia found that open defecation not only affects one’s own health, but it also affects the health of one’s neighbors. The extent of open defecation in a community is more important for a child’s development than whether the child’s household itself openly defecates.

Integrating WASH into NTD Programs: A Desk Review, 2013. WASHplus. (Link)
Soil-transmitted helminthes, schistosomiasis, and trachoma are all clearly linked to inadequate sanitation, contaminated food and water, and poor hygiene, providing an opportunity for water, sanitation, and hygiene related approaches to help change behavior and the environment.

Research Priorities for the Environment, Agriculture and Infectious Diseases of Poverty, 2013. WHO. (Link)
This report provides an evaluation of challenges presented by interactions between environment, agriculture and infectious diseases of public health importance. It explores the benefits and limitations of a more systems-based approach to conceptualizing and investigating this problem.

Sanitation Combinations: Water, Sanitation, Hygiene, and Nutrition in Kenya, 2013. G Christensen. (Link)
This research provides evidence that demand for health is highly income elastic, and easy habit formation is essential for high uptake of health interventions.

JOURNAL ARTICLES

Determinants of Moderate-to-Severe Anaemia Among Women of Reproductive Age in Tanzania: Analysis of Data from the 2010 Tanzania Demographic and Health Survey.Trop Med Intl Health, Dec 2013. C Wilunda. (Abstract)
Prevention interventions should target women with lower education or without proper sanitation facilities, and women who are pregnant, particularly if they are uneducated or in lower wealth groups.

Handwashing before Food Preparation and Child Feeding: A Missed Opportunity for Hygiene PromotionAm J Trop Med Hyg, Dec 2013. F Nizame. (Abstract)
Enteric diseases are often caused by poor hygiene and can contribute to stunting. In 50 randomly selected villages in Bangladesh, researchers collected quantitative and qualitative data on handwashing linked to child feeding to integrate handwashing promotion into a young child complementary feeding program.